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Suprascapular Nerve Block and Glenohumeral Injection in Hemiplegic Shoulder Pain: To Compare the Effectiveness on Pain and Disability  [cached]
Ay?egu?l TUBAY,Serpil BAL,Korhan Bar?? BAYRAM,Hikmet KO?YI?IT
Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi , 2012,
Abstract: Objective: The aim of this study was to compare the effectiveness of glenohumeral (GH) joint injection and suprascapular nerve block (SNB) in patients with hemiplegic shoulder pain.Materials and Methods: Thirty-six patients with shoulder pain lasting for at least 3 months were randomized into two groups in which SNB was applied in the first and GH joint steroid injection in the second group. All patients were evaluated before treatment, after 30 minutes, second week and third month after the treatment. Pain at rest, with motion and nocturnal pain were determined by the visual analogue scale. Shoulder joint range of motion was recorded for all patients. Disability status was assessed using the Functional Independence Measure (FIM). Results: There was a significant decrease in VAS scores for pain at rest, night and activity immediately after, at the second week and at the third month after the treatment in both groups. Change scores were similar in both groups. Conclusion: Although, both GH joint injection and SNB reduced pain and improved functional status at upto 3 months, there was no superiority of the one over the other. Turk J Phys Med Re-hab 2012;58:299-306.
Immediate Cementless Hemiarthroplasty for Severe Destructive Glenohumeral Tuberculous Arthritis  [PDF]
Suriya Luenam,Arkaphat Kosiyatrakul
Case Reports in Orthopedics , 2013, DOI: 10.1155/2013/426102
Abstract: The glenohumeral joint tuberculosis (TB) is rare as compared with other joints. Plaster immobilization, arthrodesis, and resection arthroplasty have been proposed as the additional treatments with anti-TB medications in severe destructive arthritis. To our knowledge, however, the surgical treatment with shoulder arthroplasty has never been reported. We present two cases of active TB with unsalvageable glenohumeral joint. The cementless hemishoulder arthroplasties were performed immediately following the radical debridement. Anti-TB medications were given for 12 months after the surgery. Postoperatively, the patients were satisfied with the rapid symptomatic relief and significant functional recovery. With the follow-up period of 5 years, the operative results were still satisfactory and the reactivation of the infection was not detected. 1. Introduction Tuberculosis (TB) continues to be a major health problem worldwide. The incidence of TB has increased since 1985, most likely due to the increase in HIV infection. Osteoarticular TB is an infrequent form of the disease, accounting for approximately 1–3% of all TB cases [1]. The incidence of osteoarticular TB affecting the shoulder is 1–2.8% of osteoarticular TB [2]. Owing to the insidious onset and nonspecific features, the diagnosis of articular TB is sometimes delayed until considerable cartilage and bone destruction occurs [3]. In an advanced stage of destruction, additional treatments were proposed in conjunction with anti-TB medications [3–12]. Immobilization of the shoulder until ankylosed in a functional position has been recommended to prevent or correct the adduction deformity [5–7]. Arthrodesis and resection arthroplasty are indicated when disabling deformity is persistent. Even though possibly providing the pain relief, these treatments commonly result in poor function and limited range of motion [8–12]. Based on our literature reviews, no report with regard to the treatment of active TB with primary shoulder arthroplasty has been described. We present two cases of active TB infection of the shoulder with advanced arthritis. Both were successfully managed by the immediate one-stage cementless hemiarthroplasty followed by anti-TB medications for 12 months. 2. Case Report 2.1. Case 1 A 50-year-old, right-handed, male chef presented in our clinic with a five-year history of right shoulder pain which was insidious in onset and gradually progressive. The range of shoulder movement was also increasingly restricted. He also had the decreased appetite and slow weight loss but no history of fever or
Surgical Treatment Options for the Young and Active Middle-Aged Patient with Glenohumeral Arthritis  [PDF]
Sanjeev Bhatia,Andrew Hsu,Emery C. Lin,Peter Chalmers,Michael Ellman,Brian J. Cole,Nikhil N. Verma
Advances in Orthopedics , 2012, DOI: 10.1155/2012/846843
Abstract: The diagnosis and treatment of symptomatic chondral lesions in young and active middle-aged patients continues to be a challenging issue. Surgeons must differentiate between incidental chondral lesions from symptomatic pathology that is responsible for the patient's pain. A thorough history, physical examination, and imaging work up is necessary and often results in a diagnosis of exclusion that is verified on arthroscopy. Treatment of symptomatic glenohumeral chondral lesions depends on several factors including the patient's age, occupation, comorbidities, activity level, degree of injury and concomitant shoulder pathology. Furthermore, the size, depth, and location of symptomatic cartilaginous injury should be carefully considered. Patients with lower functional demands may experience success with nonoperative measures such as injection or anti-inflammatory pharmacotherapy. When conservative management fails, surgical options are broadly classified into palliative, reparative, restorative, and reconstructive techniques. Patients with lower functional demands and smaller lesions are best suited for simpler, lower morbidity palliative procedures such as debridement (chondroplasty) and cartilage reparative techniques (microfracture). Those with higher functional demands and large glenohumeral defects will usually benefit more from restorative techniques including autograft or allograft osteochondral transfers and autologous chondrocyte implantation (ACI). Reconstructive surgical options are best suited for patients with bipolar lesions. 1. Introduction While the cause of primary glenohumeral osteoarthritis is largely unknown, secondary osteoarthritis is often due to trauma, acute or recurrent dislocation, or prior surgery. Primary glenohumeral arthritis typically results in posterior glenoid wear with posterior humeral head subluxation occurring in up to 50% of affected shoulders. Rotator cuff tears occur in less than 5–10% of cases of primary osteoarthritis. Joint space narrowing occurs with periarticular osteophyte formation most commonly on the inferior aspect of the humeral head. As a result, the anterior soft tissues such as the capsule and subscapularis become contracted and stiff, limiting external rotation [1]. With the growing elderly population in the US, the number of total shoulder arthroplasties performed each year has doubled over the past decade to approximately 20,000 cases [2]. While glenohumeral osteoarthritis typically affects older patients, in some cases it can affect younger, active patients causing significant pain and disability
A Rare Complication of Tuberculous Meningitis Pediatric Anterior Glenohumeral Instability  [PDF]
Kerem Bilsel,Mehmet Erdil,Mehmet Elmadag,Hasan H. Ceylan,Derya Celik,Ibrahim Tuncay
Case Reports in Orthopedics , 2012, DOI: 10.1155/2012/385782
Abstract: Dislocation and instability of the shoulder joint are rare occurrences in childhood. Traumatic, infectious, congenital, and neuromuscular causes of pediatric recurrent shoulder dislocations are reported before. Central nervous system infection in infancy may be a reason for shoulder instability during childhood. This situation, which causes a disability for children, can be treated successfully with arthroscopic stabilization of the shoulder and postoperative effective rehabilitation protocols. Tuberculous meningitis may be a reason for neuromuscular shoulder instability. We describe a 12-year-old child with a recurrent anterior instability of the shoulder, which developed after tuberculous meningitis at 18 months of age. We applied arthroscopic treatment and stabilized the joint. 1. Introduction Glenohumeral instability is an inability to maintain the humeral head centered in the glenoid fossa. Clinical cases of instability can be classified according to the degree of instability, the direction of instability, and the circumstances under which they occur like congenital, neuromuscular, voluntary, traumatic, and atraumatic recurrent instability [1]. Dislocation and instability of the shoulder joint are rare occurrences in children. Dislocations of the shoulder in infants have been reported previously and were either congenital dislocation with associated anomalies of the glenohumeral joint or with dislocations from Erb’s palsy or septic arthritis [2]. Neuromuscular causes of shoulder instability have been reported as a recurrent dislocation developed after encephalitis, cerebral palsy, and brachial plexus birth injuries [3–6]. Anterior subglenoid dislocation of the shoulder in infant following pneumococcal meningitis has also been presented as a case report of a 7-month-old boy [7]. In this report, we discuss a 12-year-old child with a recurrent anterior instability of the shoulder, which developed after tuberculous meningitis at 18 months of age. This is the first case report of a child with recurrent anterior shoulder instability due to neuromuscular imbalance that developed as a sequel of tuberculous meningitis episode. 2. Case Presentation A 12-year-old girl was admitted to our orthopaedic department for intoeing and shoulder instability. She had a previous history of tuberculous meningitis and was treated with antituberculous therapy for nine months when she was 17 months old. At that time, she was hospitalized for two months. When she was six years old, she began to feel snapping, locking, and pain in her right shoulder, which was apparent at
INESTABILIDAD GLENOHUMERAL: LO QUE EL RADIOLOGO DEBE SABER
Zamorano C,Carolina; Mu?oz Ch,Sara; Paolinelli G,Paola;
Revista chilena de radiología , 2009, DOI: 10.4067/S0717-93082009000300006
Abstract: glenohumeral instability is a common cause of pain and functional limitation of the shoulder, which involves symptomatic subluxation or dislocation of the humeral head with respect to the glenoid fossa. glenohumeral instability may be classified according to several parameters: degree, direction, timing, etiology and biomechanics of the dislocation, among others. imaging methods play an important role in the evaluation of glenohumeral instability, being all of them useful, complementary, and not necessarily mutually exclusive modalities. the following article presents a review of the main types of glenohumeral instability and related imaging findings.
Aequalis Humeral Head Resurfacing in Glenohumeral Arthritis at a Minimum Followup of 2 Years  [PDF]
Roshan Raghavan,Amitabh J. Dwyer,Andrew F. W. Chambler
ISRN Orthopedics , 2013, DOI: 10.1155/2013/541389
Abstract: Aim. To evaluate results of Aequalis humeral head resurfacing in patients with end-stage glenohumeral arthritis at a minimum followup of two years. Patients and Methods. Twenty-one consecutive patients underwent humeral head resurfacing hemiarthroplasty between 2007 and 2009. Three patients did not fulfill the inclusion criteria. 18 patients with mean age of 75.1 years (range 58–91 years) and a mean duration of preoperative symptoms of 33.6 months (range 6–120 months) were analyzed. Patients’ self-reported Oxford shoulder score (OSS) was collected prospectively and was used as an assessment tool to measure final outcome. Results. The mean initial OSS was 15 (range 3–29). The score improved by an average of 19.5 points at a mean followup of 36.3 months (range 24–54 months) to reach a mean final OSS of 34.5 (range 6–47). The improvement of OSS was highly significant with a two-tailed value less than 0.0001. The overall patient satisfaction was 94%. Conclusion. This study demonstrates Aequalis shoulder resurfacing hemiarthroplasty as a reliable procedure, away from its originating center, for improvement of shoulder function as shown by the patients’ self-reported outcome score (OSS) in end-stage glenohumeral arthritis at a minimum followup of 2 years. 1. Introduction Humeral head resurfacing was proposed as a treatment for glenohumeral arthrosis in an attempt to preserve the original anatomy and avoid humeral head resection. Preservation of humeral head maintained the native inclination, offset, head shaft angle, and version of humerus [1–3]. Other advantages include a shorter operating time, reduced blood loss, and fewer complications [4]. Another advantage is that, unlike stemmed implant, there is no need for a straight humeral canal to accommodate a long stem [4]. Resection of bone is minimal and bone cement is not used. This allows easier later revision to a conventional total shoulder arthroplasty, if required [1, 2]. It is an attractive option in both the old and the young patients [4, 5]. The disadvantage of resurfacing is the limited exposure to glenoid when wanting to perform a total shoulder resurfacing arthroplasty, but this does not affect when resurfacing the humeral head alone. The primary aim of our study was to report the results of humeral resurfacing arthroplasty in a consecutive series of patients at a district general hospital practice. 2. Patients and Methods Twenty-one consecutive patients underwent shoulder resurfacing (Aequalis, Tornier, USA) between October 2007 and November 2009 for symptomatic end-stage glenohumeral arthrosis.
Arthroscopic treatment of early glenohumeral arthritis
Giuseppe Porcellini,Giovanni Merolla,Fabrizio Campi,Andrea Pellegrini,Chandra Sekhar Bodanki,Paolo Paladini
Journal of Orthopaedics and Traumatology , 2013, DOI: 10.1007/s10195-012-0219-6
Abstract: The main finding was that soft tissue procedures (including capsulotomy and synovectomy) associated with glenoid microfractures are only suitable for patients with early arthritis and preserved humeral head shape, particularly in cases with small and centered glenoid cartilage lesions.
Surgical Treatment Options for the Young and Active Middle-Aged Patient with Glenohumeral Arthritis  [PDF]
Sanjeev Bhatia,Andrew Hsu,Emery C. Lin,Peter Chalmers,Michael Ellman,Brian J. Cole,Nikhil N. Verma
Advances in Orthopedics , 2012, DOI: 10.1155/2012/846843
Abstract: The diagnosis and treatment of symptomatic chondral lesions in young and active middle-aged patients continues to be a challenging issue. Surgeons must differentiate between incidental chondral lesions from symptomatic pathology that is responsible for the patient's pain. A thorough history, physical examination, and imaging work up is necessary and often results in a diagnosis of exclusion that is verified on arthroscopy. Treatment of symptomatic glenohumeral chondral lesions depends on several factors including the patient's age, occupation, comorbidities, activity level, degree of injury and concomitant shoulder pathology. Furthermore, the size, depth, and location of symptomatic cartilaginous injury should be carefully considered. Patients with lower functional demands may experience success with nonoperative measures such as injection or anti-inflammatory pharmacotherapy. When conservative management fails, surgical options are broadly classified into palliative, reparative, restorative, and reconstructive techniques. Patients with lower functional demands and smaller lesions are best suited for simpler, lower morbidity palliative procedures such as debridement (chondroplasty) and cartilage reparative techniques (microfracture). Those with higher functional demands and large glenohumeral defects will usually benefit more from restorative techniques including autograft or allograft osteochondral transfers and autologous chondrocyte implantation (ACI). Reconstructive surgical options are best suited for patients with bipolar lesions.
Case Report: Humeral avulsion of the glenohumeral ligament of the shoulder
RVP de Villiers, JF de Beer, K van Rooyen, PE Huijsmans, CP Roberts, DF du Toit
South African Journal of Sports Medicine , 2005,
Abstract: A 24-year-old rugby player presented to an orthopaedic surgeon with a history of dislocation of the left shoulder. It reduced spontaneously and dislocated again later during the same match. On examination there was no residual instability, but the apprehension test for anterior instability was positive. Speed s test as well as O Brien s test for SLAP (Superior Labrum Anterior to Posterior tear) lesions were negative. There were no signs of rotator cuff tear or impingement. South African Sports Medicine Vol.17(1) 2005: 27-28
Expression analysis of three isoforms of hyaluronan synthase and hyaluronidase in the synovium of knees in osteoarthritis and rheumatoid arthritis by quantitative real-time reverse transcriptase polymerase chain reaction
Mamoru Yoshida, Shigaku Sai, Keishi Marumo, Takaaki Tanaka, Naoki Itano, Koji Kimata, Katsuyuki Fujii
Arthritis Research & Therapy , 2004, DOI: 10.1186/ar1223
Abstract: High-molecular-weight (HMW) hyaluronan (average molecular weight 6–7 × 106 Da) is a major component of synovial joint fluids [1-5]. It physically acts as a viscous lubricant for slow joint movements, such as walking, and as an elastic shock absorber during rapid movements, such as running [6]. HMW hyaluronan has a variety of biologic effects on cells in vitro, such as: the inhibition of prostaglandin E2 synthesis and the release of arachidonic acid induced by interleukin-1 from cultured fibroblasts [7,8]; protection against proteoglycan depletion and cytotoxicity induced by oxygen-derived free radicals, interleukin-1, and mononuclear-cell-conditioned medium [9,10]; and the suppression of phagocytosis, of locomotion, and of enzyme release by leukocytes and macrophages [11-14]. HMW hyaluronan has been shown to suppress the degradation of cartilage matrix induced by fibronectin fragments [15,16] and cytokines [17]. Moreover, it has been shown to relieve joint pain by masking free nerve ending organelles in animal experiments [18,19]. Hence, it is suggested that HMW hyaluronan is an indispensable component in the maintenance of articular joint homeostasis. Reductions in the concentration and average molecular weight of hyaluronan in knee synovial fluids from patients with osteoarthritis (OA) or rheumatoid arthritis (RA) have been reported [2,3,20-25]. These reductions indicate hyaluronan's involvement in the pathogenesis of these joint disorders and are reflected in the pathological changes of hyaluronan metabolism.Hyaluronan is synthesized by hyaluronan synthases (HASs) located at the plasma membrane of cells [26]. Three HAS isoforms, encoded by three distinct genes, are expressed in human knee synovium [27]. It is believed that joint fluid hyaluronan is mainly supplied from type B cells – proper synoviocytes – of the synovial lining [2-5,28]. Little is known about hyaluronan catabolism in synovial fluid. It is thought that hyaluronan is eliminated by the lymphatic or
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